NCCN临床实践指南_外阴癌（鳞状细胞癌）（2019.V1）英文版

Vulvar Cancer Squamous Cell Carcinoma Version 1 2019 August 30 2018 NCCN org NCCN Clinical Practice Guidelines in Oncology NCCN Guidelines Continue Version 1 2019 08 30 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN Continue NCCN Guidelines Panel Disclosures Gynecologic oncology Medical oncology Radiotherapy Radiation oncology Pathology Patient advocacy Discussion Section Writing committee NCCN Nicole McMillian MS Jillian Scavone PhD Shari Damast MD Yale Cancer Center Smilow Cancer Hospital Oliver Dorigo MD PhD Stanford Cancer Institute Patricia J Eifel MD The University of Texas MD Anderson Cancer Center Christine M Fisher MD MPH University of Colorado Cancer Center Peter Frederick MD Roswell Park Cancer Institute David K Gaffney MD PhD Huntsman Cancer Institute at the University of Utah Ernest Han MD PhD City of Hope Comprehensive Cancer Center Warner K Huh MD University of Alabama at Birmingham Comprehensive Cancer Center John R Lurain III MD Robert H Lurie Comprehensive Cancer Center of Northwestern University Andrea Mariani MD Mayo Clinic Cancer Center David Mutch MD Siteman Cancer Center at Barnes Jewish Hospital and Washington University School of Medicine Wui Jin Koh MD Chair Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance Nadeem R Abu Rustum MD Vice Chair Memorial Sloan Kettering Cancer Center Sarah Bean MD Duke Cancer Institute Kristin Bradley MD University of Wisconsin Carbone Cancer Center Susana M Campos MD MPH MS Dana Farber Brigham and Women s Cancer Center Kathleen R Cho MD University of Michigan Rogel Cancer Center Hye Sook Chon MD Moffitt Cancer Center Christina Chu MD Fox Chase Cancer Center Rachel Clark Massachusetts General Hospital Cancer Center David Cohn MD The Ohio State University Comprehensive Cancer Center James Cancer Hospital and Solove Research Institute Marta Ann Crispens MD Vanderbilt Ingram Cancer Center Christa Nagel MD Case Comprehensive Cancer Center University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute Larissa Nekhlyudov MD MPH Dana Farber Brigham and Women s Cancer Center Amanda Nickles Fader MD The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Steven W Remmenga MD Fred 146 3 10 It is included in the Discussion section VULVA 9 Therapy for Recurrence Recommendation revised Radical excision and unilateral or bilateral inguinofemoral LN dissection if lymphadenectomy not previously performed VULVA B Principles of Surgery 1 of 4 Tumor Margin Status Third bullet revised In the setting of a close or positive surgical tumor margin 0 mm but 8 mm evidence is lacking to support decreased recurrence and improved survival with re resection of disease or adjuvant local radiation to the primary tumor site 2 of 4 Surgical Staging New bullet added Lymphadenectomy or SLN evaluation can be omitted in patients with stage IA primary disease with clinically negative groins due to a 1 risk of lymphatic metastases Bullet removed Some patients are not candidates for lymphadenectomy including those with stage IA disease due to a 1 mm invasion or T2 Wide local resectione f Observe Lateral lesion 2 cm from vulvar midline Biopsy Radical local resection or modified radical vulvectomy and ipsilateral groin node evaluatione Sentinel lymph nodes SLNs g or ipsilateral groin lymph node LN dissection Radical local resection or modified radical vulvectomy and bilateral inguinofemoral groin node evaluatione SLNsg or bilateral inguinofemoral groin LN dissection Vulvar midline lesion anterior or posterior Assessment of primary tumorh and nodal surgical pathology See Adjuvant Therapy based on Primary Tumor Risk Factors VULVA 3 and Nodal Evaluation VULVA 4 NCCN Guidelines Index Table of Contents Discussion Version 1 2019 08 30 18 National Comprehensive Cancer Network Inc 2018 All rights reserved The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN NCCN Guidelines Version 1 2019 Vulvar Cancer Squamous Cell Carcinoma Note All recommendations are category 2A unless otherwise indicated Clinical Trials NCCN believes that the best management of any patient with cancer is in a clinical trial Participation in clinical trials is especially encouraged Printed by Maria Chen on 8 30 2018 9 50 56 PM For personal use only Not approved for distribution Copyright 2018 National Comprehensive Cancer Network Inc All Rights Reserved VULVA 3 See Surveillance VULVA 8 eSee Principles of Surgery VULVA B iThe management of positive margins for HSIL non invasive disease should be individualized jSee Principles of Radiation Therapy VULVA C kOther primary risk factors include close tumor margins lymphovascular invasion tumor size depth of invasion and pattern of invasion spray or diffuse Nodal involvement as an indicator of lymphovascular space invasion may a